1275719429 NPI number — JOHN OPALKA OD & ASSOCIATES, LLC

Table of content: (NPI 1275719429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275719429 NPI number — JOHN OPALKA OD & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN OPALKA OD & ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROFESSIONAL CONTACT LENS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275719429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 N MCKEAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KITTANNING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16201-1565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-543-2702
Provider Business Mailing Address Fax Number:
724-543-5171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 N MCKEAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-543-2702
Provider Business Practice Location Address Fax Number:
724-543-5171
Provider Enumeration Date:
01/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OPALKA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
724-543-2702

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000706 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01720857 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1235129941 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 411447 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1275719429 . This is a "NPI GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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